Diabetes Care Volume 43, January 2020 3

EDITOR'S COMMENTARY
Diabetes Care in 2020: Following Matthew C. Riddle

and Leading the Stories of

Diabetes
Diabetes Care 2020;43:3–4 | https://doi.org/10.2337/dci19-0065

With the simple turning of a calendar
page, 2020 is upon us, as is the time for
the annual New Year message from the
editorial committee of Diabetes Care.
Each year we highlight the past year’s
activities and offer a preview of what lies
ahead. An important event in 2019 was
the announcement of impact factors for
scientific journals. The yearly statement
of current impact factors revealed an-
other clear increase for Diabetes Care,
from 13.4 to 15.3, placing us among the
elite journals in any specialty. We are
proud of this ranking and hope for a
further increase next year.
Last year’s editorial outlined some
goals, policies, and procedures that con-
tribute to the journal’s character (1).
Today we offer a wider perspective. Di-
abetes Care is the translational journal
of the American Diabetes Association
(ADA), linking basic science to clinical
science and care. Providing a broad range
of expertise, the editorial committee is
composed of scientists, clinicians, epi-
demiologists, and experts in writing,
editing, and medical publication. While
we all started with deep experience in
one or more of these fields, together we
are called upon to extend our roles to
become journalists. This means more
than picking the best scientific studies
as they are submitted. It involves ac-
tively soliciting, improving, and discus-
sing articles that, collectively, form the
stories that matter most to our commu-
nity. Storiesdthis is a term not usually
used in scientific discourse, but it is
central to all forms of journalismdare
important. They explore unmet needs,
controversies, or barriers to attaining
our goals. In connecting various aspects
of a complex issue, they can reveal its
broader relevance. They concern shared
experiences and common problems and
can motivate change.
To illustrate this point, consider the
story of the costs of diabetes. People
with diabetes and medical providers
who care for them are very aware of the
rising costs of the drugs and devices
needed to manage diabetes. Insulin in
particular has risen in price, especially in
the U.S. In low-income nations the cost
and availability of insulin can be profound
concerns. However, reliable information
about the causes of this increase, as well
as about differences in costs and access to
care between regions and health plans,
has been limited. The cost-effectiveness
of various therapies and ways to organize
the delivery of care are major concerns.
The ADA and Diabetes Care have made
efforts to obtain and report accurate
information on this complex and emo-
tionally charged story. In May and June of
2018, four important articles appeared in
Diabetes Care. The May issue included an
ADA Statement on the costs of diabetes
in the U.S. in 2017 (2), and nine reports of
cost-related studies were summarized
in a Commentary (3). The June issue
presented a Perspective on access to
insulin in the U.S. and globally (4) and
an ADA Statement on insulin access and
affordability (5). The flow of information
on costs related to diabetes has contin-
ued: at last count, 29 articles directly
addressing this topic have been pub-
lished in Diabetes Care in 2018 and
2019. In addition, working groups in
the ADA are preparing two scientific
reviews on the cost-effectiveness of
therapies for diabetes, soon to appear
in Diabetes Care.
The evolving cost story is of interest
to the whole diabetes community. It
affects nearly all of us directly or in-
directly. Cost remains a leading barrier
to effective treatment for many people. It
is potentially a remediable problem, and
the way toward a solution likely depends
on high-quality descriptive data, epide-
miologic analyses, and interventional
studies. One feature article of particular
interest, published in the November
2019 issue of Diabetes Care, summarized
more than two decades of work by a
group in Hong Kong leading to an in-
tegrated diabetes care system (6). Their
population-based approach was able
to reduce hospitalizations and mortal-
ity in a type 2 diabetes population
by ;50% while significantly reducing
overall costs as well. Whether this kind
of success can be reproduced elsewhere
is another part of the story. We expect to
publish many more cost-related studies
in 2020.
Of course, this is not the only impor-
tant story relevant to the care of diabetes

Division of Endocrinology, Diabetes & Clinical Nutrition, Oregon Health & Science University, Portland, OR
Corresponding author: Matthew C. Riddle, riddlem@ohsu.edu
© 2019 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and
the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.
4 Editor’s Commentary
today. Another example is the story of
the relationship between diabetes and
heart disease. Is diabetes a common but
separate disorder that is often asso-
ciated with heart disease, or is diabetes
itself a cause of many cardiac events?
Emerging evidence, some of it derived
from recent studies of the sodium–
glucose cotransporter (SGLT) inhibitor
drugs, favors the latter interpretation. In
any case, management of diabetes is
intertwined with that of heart disease.
Recent feature articles in Diabetes Care on
this story have considered the future of
cardiovascular outcome trials involving
drugs for diabetes (7), the emergence of
heart failure as a complication of diabetes
(8), and the evidence from the Diabetes
Control and Complications Trial (DCCT)
and its follow-up study linking hyper-
glycemia over time to long-term cardiac
outcomes (9).
Yet another active story concerns the
use of devices for continuous glucose
monitoring (CGM) to refine manage-
ment of diabetes. Two years ago, Diabetes
Care published a group of commentaries
and consensus statements on the use of
CGM (10–13). Further reports have added
to the story (14), and the expected
harvest of scientific and clinical infor-
mation based on this new technology is
starting to come in. This month’s issue
contains a collection of articles and a
Commentary on the application of CGM
to research and care for type 1 diabetes
(15). This story, too, will continue to
grow.
So, Diabetes Care is trying to go be-
yond the numbers to the meaning of the
articles we publish, to develop stories
that matter to the community. At the
same time, we will continue to look for
the entirely new physiologic insights,
drugs, or treatment approaches that will
become the big stories of the future.
Please help us by continuing to send us
your best research studies and brilliant
new insights. We will keep working to
give the diabetes community the reli-
able new information it must have to
improve care.
Funding. This work was supported in part by the
Rose Hastings and Russell Standley Memorial
Trusts.
Duality of Interest. M.C.R. reports receiv-
ing research grant support through Oregon
Health & Science University from AstraZeneca,
Eli Lilly, and Novo Nordisk and honoraria for
consulting from Adocia, AstraZeneca, Dance, Eli
Lilly, GlaxoSmithKline, Novo Nordisk, Sanofi, and
Theracos. These dualities of interest have been
reviewed and managed by Oregon Health &
Science University. No other potential conflicts of
interest relevant to this article were reported.
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